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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm )L:k O k e e GU4�- Phone No.
Address of Firm
Location of proposed work —RJ N t LV S
Describe fully nature of permit requested cJ c3 /n } S 2✓ i/ 0�L
Starting date 14 92 f I I / 9 `) 9 Approx.time for completion t rYl or n fl
Call before you dig no. i o19 9 kLA -7?1 Traffic Services Control No.
Show sketch of proposed work or furnish To be fitted out bV Towltt of So Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut
No.cuts
C—\/S Amt.of Deposit 8 by
~ O Cash O Check 8
Cut size after Perm. Patch
�l No.Cuts
Final Billing 8
Amt.Due Payee 8
Amt. Due Town 8
Applicant is responsible for contacting
the Police Dept. and C.S.Y.D. by date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:
Title: D.L.f/
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
;-C:T'W;.-L :REI ORIE heou Ave -- Eno oldsowlsss 15 a 54:
--TrE" -6014 -04
-81 44 1 N,111 2 T5
"QUEST TIME- 15352 DATE. .
70554 r m , ✓ - r . . . . .SOUTH WINDSOR GR I D CODE. K?4 x
RwDRESS- - . . . r x f---25 E;UC:?XLA1YZ"r RD,
IMAREST STREET' E 5_1 L 3 ... . ...I...
TYE F IDRK— G3 R AGPOWI SV
*-ZZ'D
"T SIDE -,;-,kF B'] D&43r
INEW CVS STORE.%.
Ell i in NsL'9
ALTER. . . . . . .
f-*-'T9:'-PT DATE, STARIF TIME, . 7Z.0-A.,-4
�)r . . . FAXT
CK&L EACH, 7 i 35-4
SEW1,110ES
P&DRESS- - 112 PROSPECT HILL RD, EAST WINDSORI CT WOW
iR 11"C."INIG 44"C'MIX. SAME
ISSUED To,' 1 DATE/TIME ARRIVED.- TIME LEFTI COMPLETF—D,
11 DATE* TIMEi Byl 21 DATE* TIMET
PERSe 4,41
ECEF::1 RE YOU D'-IrG CT.1
_FHx FF'OLLOWAIN13 144-2. SAIG., WERE T RAN-EiPA,IT TED TO YOU TCWAYx
oa/32/lsss 171 .AS a154 STATION: SW
'"914607" 199914QaT22 19ST1420977 19SS140OS80 ISS914plIll
IGSS140114-9 '"140114G ISS9140122S ISSS1401247 199%461251
fps"51271 1599145112S '"51401335 ISSS140ANT5 I Sr'91401017 19ST145131S
IS991401340 IS9%4013sa
TOTAL CKOC,
CEER S -N1'341 -.:31G*1'I? - ' VNT mi- 0- � E'VONINKB.v
YOU T:HE MOF,10142-1,44c-.4
COCO NIGHT-Z-2-2-Z-2-2
96 � / \\ 'IOO.T
100
' -
/O
f
Jf
t ' WATER SERVICE BELOW
\ °NNECT TO rXtST. C.B. r /o STORM (12' CLEAR) /
WITH 15' CPP! AT 2' ABOVE 8' I ccO I '
�q t \o qu, WATER ONES To , /
/ ° \ EXISTING INVERT t F , '/—
vN \ -4_6� MIN. COVER ❑
/ -l
mn
1.1`� !,'• i \ 15" CPP � ------WA R
r 1
AS \\ 10o.85+ �� Q f
opoSED
c- C.942 . �
OFFICE Y
I TYP 93.2
T.F. 97.41PW. �
p00 S.F. '" Y FOR SAVINGS
$
8, o N / F SOCIET
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/ �
PIAACD OD
SE 1 � 1 t
CVS
+ _ - p 'Op OSED
V-A / ^,
FFE � W�,
I o m
I
I u
/ \ 0% /
� < 1
all �1-
t /
m \ r .71 + I <<
101.35
SNET CO.
N/ IF $ 1
1 *.�
00 Pl
L
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OAD
R
cleanout details as reviewed and approved I� t N D A _
BDCKL o r
;gal approval plans.
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